What's Next?

So I've been trying to think of what to write about next.

It's weird how after a while what might have seemed strange and interesting at one point starts to seem normal or expected. I am also afraid of repeating myself. While there are new challenges and frustrations each day, they have started to follow similar patterns - child in heart failure being treated for pneumonia instead; child with kidney tumor waiting weeks for a surgical consult (when surgery is the only treatment option); children waiting weeks for echocardiograms because the one doc who performs them has been on vacation or had meetings to attend...

On a different note a group of people with Physicians For Peace is leaving tonight after a week-long visit. What a disappointment that has been.

Not long into their visit I began to notice that my presence here was being completely ignored. I have finally put a few things together and made more sense out of it all.

Physicians For Peace has been working with George Washington University in Washington, DC
for several years to put together a pediatric and a surgical residency program here in Asmara. Various people have made a handful of visits to Eritrea over the years with this purpose in mind. This most recent visit was the last one planned before both programs become operational in October.

My trip and my work here are completely incidental. I e-mailed PFP (as well as many other programs listed on the American Academy of Pediatrics website) a year ago inquiring about the possibility of doing just what I am doing right now. One woman in the organization thought my coming here would be "ideal" and indicated that their organization was just what I was looking for.

It turns out that PFP has never sent a pediatric resident to Eritrea before.

And despite the fact that two of the major players in the group that just came through knew about my work here well in advance of their arrival, they never thought to utilize me.

Still, once they were here I tried to inform them about some of the major obstacles I have run into (nurses and doctors refusing to give medications at doses other than what they are used to despite being shown multiple references indicating the doses being prescribed; the inability to get any vital sign other than temperature recorded, ever, even during a blood transfusion; the refusal to draw any labs after 3pm) - the types of things that will likely be problems even after the doctors begin their training. But no one wanted to hear it. Nor would they hear that the current residency-trained pediatricians (future attending physicians for the residency program) are completely out-dated in many of their practices and part of the problem.

Rather than use my experience as a learning tool, a road map of danger areas to be considered before American doctors come here and bang their heads against the same walls I am, they chose to ignore my negativism and chalk up my problems to the fact that I am not an entire residency program.

The good part of all of this (if there is any) is that I have learned the reason for some of my frustrations.

The current attending physicians will not initiate any of my suggested changes on their own because they are waiting for everything to happen in October.

The WHO guidelines are meant for medical personnel who are not doctors to use out in the field. They are guidelines for the lay-people and triage workers in rural areas. However, the minister of health has ordered everyone, including the doctors, to follow the WHO guidelines as a strict protocol, not as guidelines (just as I have observed). He does not trust anyone, including the doctors, to think for themselves.

And so on.

So I have comforted myself by focusing on my small successes. The patients I have helped directly. The ideas I have planted in the minds of the young doctors. The compassion and integrity I bring with me every day to the hospital...